Please note that you need a current Family level membership or higher to receive the discounted registration for Summer Camp. Family Memberships are only valid for the immediate family (i.e Parents and Children - not Grandchildren)

Non Member Registration Fee*

Price:$200.00

STOP. You MUST be a 2020 member of the Refuge to enroll during the priority registration period. (Prior to 05/11/2020)
To become a member visit https://quoguewildliferefuge.org/membership/ or call 631.653.4771

Are you a 2020 Member?*

No

Yes

Payment Type*

Enter name on check below.*

Send checks to PO Box 492, Quogue NY 11959 - *Check must be postmarked within one week of this form submission and received before camp begins to ensure your reservation.

Total

$0.00

Photo Consent

I CONSENT to the use of photographs, video recordings and/or name by the Quogue Wildlife Refuge (QWR) for the purpose of advertising (e.g. QWR website, brochures, Facebook page, program flyers). I agree that the actual material involved, such as photographs or recordings, are to remain property of QWR.

Photo Consent

I refuse to give photo consent for publication usage

Health and Emergency Contact Information

Emergency Contact Name #1*

FirstLast

Emergency Contact Phone #*

Relationship to Child*

Emergency Contact #2*

FirstLast

Emergency Contact Phone #*

Relationship to Child*

*** Please List Your Child’s Medications & Allergies Below****

Any other Medical or Behavioral History (restrictions/limitations, special needs, dietary concerns, etc…):*